`J7503` Tacrol envarsus ex rel oral

Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg

Medicare coverage: Special coverage instructions apply
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 0 units per day (clinical), rationale: Oral Medication; Not Payable
Outpatient hospital: max 120 units per day (clinical), rationale: Prescribing Information
DME supplier: max 3600 units per day (clinical), rationale: Prescribing Information

Medicare pricing for J7503

Medicare Part B drug payment limit (ASP, October 2026)

J7503 payment limit: $1.863 per 0.25 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.

NDCs that bill under J7503 (CMS ASP NDC-HCPCS crosswalk, October 2026)

68992-3010-01 Envarsus XR, Veloxis Pharmaceuticals, Inc.: 400 billing units per package (1 POUCH in 1 CARTON / 1 BOTTLE in 1 POUCH / 100 TABLET, EXTENDED RELEASE in 1 BOTTLE)
68992-3010-03 Envarsus XR, Veloxis Pharmaceuticals, Inc.: 120 billing units per package (1 POUCH in 1 CARTON / 1 BOTTLE, PLASTIC in 1 POUCH / 30 TABLET, EXTENDED RELEASE in 1 BOTTLE, PLASTIC)
68992-3040-01 Envarsus XR, Veloxis Pharmaceuticals, Inc.: 1600 billing units per package (1 POUCH in 1 CARTON / 1 BOTTLE in 1 POUCH / 100 TABLET, EXTENDED RELEASE in 1 BOTTLE)
68992-3040-03 Envarsus XR, Veloxis Pharmaceuticals, Inc.: 480 billing units per package (1 POUCH in 1 CARTON / 1 BOTTLE, PLASTIC in 1 POUCH / 30 TABLET, EXTENDED RELEASE in 1 BOTTLE, PLASTIC)
68992-3075-01 Envarsus XR, Veloxis Pharmaceuticals, Inc.: 300 billing units per package (1 POUCH in 1 CARTON / 1 BOTTLE in 1 POUCH / 100 TABLET, EXTENDED RELEASE in 1 BOTTLE)
68992-3075-03 Envarsus XR, Veloxis Pharmaceuticals, Inc.: 90 billing units per package (1 POUCH in 1 CARTON / 1 BOTTLE, PLASTIC in 1 POUCH / 30 TABLET, EXTENDED RELEASE in 1 BOTTLE, PLASTIC)

Physician Fee Schedule (CY 2026, RVU26D)

Status E: excluded from the PFS by regulation.

Payer policies and prior authorization for J7503

0 of 1 payer prior-auth lists that name J7503 require prior authorization or set conditions.

Payer coverage policies that name J7503

J7503 appears in 3 coverage policies from Aetna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Erectile Dysfunction and Peyronie's Disease (0007)	not covered	Jul 29, 2026	payer document
Aetna	Fetal Echocardiography and Magnetocardiography (0106)	listed, no stance	Mar 26, 2026	payer document
Aetna	Nipocalimab-aahu (Imaavy) (1083)	listed, no stance	Aug 11, 2026	payer document

Recent prior-auth changes

Apr 1, 2025: PA removed, UnitedHealthcare
Mar 1, 2025: PA added, UnitedHealthcare
Jan 1, 2025: PA removed, UnitedHealthcare

Medicaid fee-for-service

Prior authorization required or conditional in WA.

AZ: $1.86 (outpatient_hospital), effective Apr 1, 2026
IN: $1.60 (professional, Advanced Practice Nurse (85%), non-facility), effective Apr 1, 2026
KY: $0.00 (asc), effective Jan 1, 2026
MA: $1.50 (dme_rates), effective Mar 1, 2026
OH: $1.86 (provider_administered_drugs), effective Apr 1, 2026
OK: $1.86 (physician, non-facility), effective Jul 1, 2026
VA: $1.86 (medical), effective Apr 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $1.86 (kidneycenters), effective Jul 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

J7503 Tacrol envarsus ex rel oral